Evaluation Of Clinical Response And Toxicities Of Cisplatin Plus Etoposide Versus Paclitaxel Plus Carboplatin In The Treatment Of Advanced Small Cell Lung Carcinoma
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 4
Abstract
Background: Small cell lung cancer (SCLC) is a major cause of cancer deaths and accounts for 20% to 25% of all lung cancer1 . It follows a more rapid clinical course than non-small-cell lung cancer. In contrast to nonsmall-cell lung cancer, however, small-cell lung cancer is very sensitive to cytotoxic agents and radiation therapy2 . Material And Methods: This Quasi-experimental prospective study done in the oncology department of different hospital in Dhaka to evaluate the clinical response and toxicities between Cisplatin plus Etoposide Versus Paclitaxel plus Carboplatin in the treatment of advanced Small cell lung carcinoma. Result: A total of 60 patients with histologically confirmed small cell lung cancer with advanced stage were selected for the study upon fulfillment of inclusion and exclusion criteria. Patients with Karnofsky performance scale status score below 60 were excluded and age range of patients for the study considered between 30 to 70 years with any sex. Besides the debilitating co-morbidity including severe heart disease, uncontrolled diabetes mellitus or hypertension were also excluded to avoid confounding effect. Thirty of the patients were allocated with Cisplatin-Etoposide based regimen and was leveled as arm-A and another 30 were allocated with Paclitaxel-Carboplatin basedt regimen and leveled as Arm-B. Following chest examination, both the arms had not significant (p>.05) baseline parameters. In the two arms CxR (P/A and lateral view) findings; presence of ‘ lesion’ (Radio opaque shadow), side, zone and size of the lesions were found to be statistically indifferent (p>.05). Besides these, Performance status was also statistically insignificant (p>.05). To compared the toxicities, nausea & vomiting were found to be more in arm-A (p>.05) and diarrhea was found to be more in arm-B (p>.05) in several cycles. Sensory neuropathy was found to be only in arm-B and hearing loss was found to be only in arm-A to occur rarely among study subjects. In the initial cycles of treatment only a patient developed hypersensitivity reaction in arm-B, Patient in both the treatment arms were not statistically significant to comparing Haemoglobin, platelet and WBC count during treatment (p>.05). To assessment of symptoms (cough, haemoptysis, chest pain, and breathlessness), after 2nd cycle of chemotherapy, cough and breathlessness were relived better in arm-B (p>.05) and after 4th cycle of chemotherapy, cough, chest pain and breathlessness were relived better in arm-B than arm-A (p>.05). During follow-up period cough and haemoptysis were found to be relived better in arm-B than arm-A (p>.05). To compared the responses in terms of relieving clinical signs (palpable supraclavicular lymph node, abnormal percussion, abnormal vocal resonance and added sound), after 2nd cycle of chemotherapy, abnormal vocal resonance and added sound found to be relieved better in arm-B and after 4th cycle, all signs were relived better in arm-B than arm-A (p>.05). During follow-up period arm-B showed superior response in terms of relieved of signs than arm-A (p>.05). To followed radiological evaluation, regarding patient’ s response in terms CxR (P/A view) finding during chemotherapy, assessed after 2nd and 4th cycle chemotherapy, regression of tumour were found to be significantly more in arm-B than arm-A (p>.05). Response to tumour regression revealed by CxR (P/A view) finding during follow up period, arm-B showed superior response than arm-A (p>.05). Over the five assessment period (after 2nd and 4th of chemotherapy and at three follow-up), trend analysis on tumour regression (CxR P/A view) showed steady decline over the treatment period and follow up. Treatment arm ‘ B’ showed steeper decline in comparison to treatment arm-A. Over all, treatment arm-B showed better response on regression of tumour in comparison to treatment arm-A. Conclusion: Combination chemotherapy (two to more drugs) is more effective than single agents chemotherapy in the treatment of Small cell lung carcinoma. This study was to observe and to compare the clinical response and toxicities of two chemotherapy schedules (cisplatin-etoposide vs paclitaxel-Carboplatin) for patients with advanced small cell lung cancer. It is to be concluded that Paclitaxel Plus Carboplatin based chemotherapy schedule showed better response in advanced Small cell lung Carcinoma.
Authors and Affiliations
Dr. Md. Zillur Rahman Bhuiyan, Dr. Atiar Rahman, Dr. Md. Golam Hafiz
Keywords
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- EP ID EP572311
- DOI 10.9790/0853-1804045360.
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